Month: February 2016

Abortion Is Way More Common Than Most Voters Think

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By Gregory M. Lipper

A new Vox survey reveals that a majority of registered voters underestimate the rate of abortion, and that the abortion rate is most likely to be understimated by men, college graduates, and those with higher salaries:

More educated and higher-income Americans are especially likely to believe that abortion is rare.

For example, 54 percent of Americans without a college degree underestimate abortion rates, compared with 70 percent of those with graduate degrees. And 51 percent of those earning less than $50,000 underestimate the frequency of abortion, compared with 69 percent of those earning more than $175,000.

The split happens when you look at gender, too. Women would near certainly have more experience with abortion than men. Our poll shows that 67 percent of men underestimate the frequency of abortion, compared with 57 percent of women.

Fortunately for those who support abortion rights, no Supreme Court Justices are wealthy, well-educated men…

Greg Lipper (@theglipper) is Senior Litigation Counsel at Americans United for Separation of Church and State.

‘The Week in Health Law’ Podcast

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By Nicolas Terry and Frank Pasquale

This week we interviewed Nicole B. Porter at the University of Toledo College of Law. Nicole has served as Associate Dean for Academic Affairs at Toledo. Her research interests focus on the employment rights of women and individuals with disabilities. She teaches Employment Discrimination, Disability Law, Criminal Law, Contracts, and Feminist Legal Theory.
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Nicole’s expertise on the Americans with Disabilities Act is nonpareil, and she discussed several dimensions of ADA practice and advocacy. Nicole’s recent scholarship in the area includes Special Treatment Stigma After the ADA Amendments Act, The Difficulty Accommodating Healthcare Workers, Withdrawn Accommodations, and The New ADA Backlash. The show includes both background on the ADA’s purpose and initial reception, as well as up-to-date analysis of its present application.

The Week in Health Law Podcast from Frank Pasquale and Nicolas Terry is a commuting-length discussion about some of the more thorny issues in Health Law & Policy. Subscribe at iTunes, listen at Stitcher Radio, Tunein and Podbean, or search for The Week in Health Law in your favorite podcast app. Show notes and more are at TWIHL.com. If you have comments, an idea for a show or a topic to discuss you can find us on twitter @nicolasterry @FrankPasquale @WeekInHealthLaw

Should healthcare systems implement routine recontacting services in clinical practice? Some legal and logistical considerations

Genetics in Medicine 1 Comment

By Daniele Carrieri, Angus Clarke, Anneke Lucassen, Susan Kelly

Advances in genetic and genomic medicine are resulting in better diagnosis and treatment of some health conditions, and the question of whether former patients should be recontacted is therefore timely. Recontacting patients to inform them of new information or new testing, that could be relevant to their health or that of their biological relatives is made more pressing by the increasing use of whole genome approaches in healthcare, where variants previously of unknown significance (VUSs) may now have known disease effects.  However, there is currently no consensus about whether or not healthcare professionals have a duty or responsibility to recontact former patients in light of this new information. There is also very little empirical evidence in this area. In a recent article published in Genetics in Medicine, we present the results of a survey of recontacting practices of clinical genetics services across the United Kingdom (UK). As far as we know, this is the first study that specifically explores current recontacting practices in clinical genetic services.

One of the questions of the survey asked was whether clinical genetics services should implement routine recontacting systems. The majority of genetic services were undecided for several reasons.  The main arguments given in favor of implementing such systems revolved around patient choice and the idea of keeping patients up to date.  The main arguments against pointed to the logistical difficulties of implementing recontacting systems and the possible legal implications of doing so, if that were seen as establishing a new standard of care without the additional resources required for this to be a sustainable activity. Read More

NHPC 2016: Growing National Debt Requires Strategic Changes in Health Care Spending

The Petrie-Flom Center Staff Leave a comment

By Cornelia Hall, Master of Public Policy Candidate, Harvard Kennedy School, Class of 2017

This is the third entry in a three-part series on the AcademyHealth National Health Policy Conference, held in Washington, DC, on February 1-2.  Read the first entry here and the second entry here.

The national debt as a percentage of GDP has spiked in the last several years, rising from approximately 35% in 2007 to nearly 74% in 2015.  Federal budget projections suggest that this trend will continue, with the debt nearly exceeding the size of the economy by 2040.  Discussion about these predictions frequently returns to the topic of health care.  Indeed, as the “baby boomer” generation retires and enrolls in Medicare, federal health care spending is expected to rise dramatically.  In an NHPC plenary session, federal budget experts explored this topic and discussed possible methods of controlling the growth of health care spending in years to come. Read More

What is the IMD Exclusion that everyone is talking about?

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By Emma Sandoe

A less covered provision of Medicaid law that has been in existence since the establishment of the program in 1965 and has been making some news over the past several months, the IMD exclusion is a provision that restricts Medicaid payments for certain institutions, potentially reducing the access to available services for low-income individuals with mental illnesses. If you haven’t been hearing everyone talking about it… well, I guess you talk with fewer health policy nerds than I do.

What is the IMD exclusion?

According to the good people at the National Alliance on Mental Illness (NAMI), the IMD exclusion can be defined as: Institutions for Mental Disease (IMDs) are inpatient facilities of more than 16 beds whose patient roster is more than 51% people with severe mental illness. Federal Medicaid matching payments are prohibited for IMDs with a population between the ages of 22 and 64. IMDs for persons under age 22 or over age 64 are permitted, at state option, to draw federal Medicaid matching funds.

Why does Medicaid have this provision?

This is because when Medicaid first started, states were responsible for the care of people with severe mental illness. States cared for many people with mental illnesses in a custodial setting; essentially states often were providing people a place to sleep but no mental health services. When drafting the Medicaid bill, the federal government did not want to supplant this existing state program with federal Medicaid funding. Additionally, while President Johnson was notorious for not spending a large amount of time on the cost of Medicare, the addition of these services would add $1.8 billion to the Medicaid budget, nearly doubling the first year price tag.

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NHPC 2016: Care Integration as a Potential Alternative to Health Care Consolidation

The Petrie-Flom Center Staff Leave a comment

By Cornelia Hall, Master of Public Policy Candidate, Harvard Kennedy School, Class of 2017

This is the second entry in a three-part series on the AcademyHealth National Health Policy Conference, held in Washington, DC, on February 1-2, 2016. Read the first entry here. 

Consolidation in the health care sector, particularly among providers and private insurers, has been rising since the Affordable Care Act passed in 2010.  Major movement is currently underway among the “Big Five” private insurance companies: Humana, Cigna, UnitedHealthcare, Aetna, and Anthem.  Two proposed “horizontal” mergers, currently under review by the Department of Justice Antitrust Division, would reduce these “Big Five” to the “Big Three.”  In this context, NHPC panelists discussed private sector consolidation’s potential impact on the cost, quality, and coverage of health care.  Several panelists expressed concern about the effects of consolidation on patients and the costs of services.  They also indicated, however, that the health care system’s ongoing transition to more coordinated care could help to offset potentially negative consequences of consolidation.

As the Justice Department analyzes the proposed mergers, industry analysts on the NHPC panel suggested that insurer consolidation could negatively affect patient experiences in the health care system.  Sarah Lueck of the Center on Budget and Policy Priorities noted that the Affordable Care Act was designed to improve market competition, but the proposed insurance mergers could increase enrollees’ premiums and harm transparency for consumers.  She pointed out that this competition among providers also drives quality of care, which could suffer under consolidation. Read More

Tracking Oil and Gas Laws

Temple University Center for Public Health Law Research Leave a comment

For three and half years, the Intermountain Oil & Gas BMP Project has been working on a collection of datasets and maps at LawAtlas.org that focus on water quality, water quantity, and air quality statutes and regulations within oil and gas development in the United States, specifically related to horizontal drilling and hydraulic fracturing (better known as fracking).

Most recently this collection of seven datasets expanded from 13 states (CO, LA, MT, ND, NM, NY, OH, OK, PA, TX, UT, WV, and WY) to 17 states (adding IL, CA, AR, and AK) and added regulations from four federal agencies – Bureau of Land Management, Bureau of Indian Affairs, U.S. Forest Service, and the Environmental Protection Agency. The research, which was funded in part by the Public Health Law Research program (PHLR), is meant to shed light on the regulations in place in the industry, and establish a baseline for how the industry is regulated.

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Matt Samelson, JD

Matt Samelson, JD, a consultant attorney at University of Colorado Boulder Getches-Wilkinson Center for Natural Resources, Energy, and the Environment, spoke with PHLR about his work and the recent developments in this project.

PHLR: What is the mission of the Intermountain Oil and Gas BMP Project? Read More

Data Mining and Pregnancy Prediction

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By Katherine Kwong

Our private health decisions may not be as private as we’d like to think. A recent article in the Wall Street Journal revealed a potentially uncomfortable situation: employers using health care analytics companies to mine employees’ health data to determine which employees may be about to make certain health decisions.

While this type of data analytics can be used to predict a variety of health conditions (ranging from an increased risk of diabetes to back surgery to pregnancy), the most attention-grabbing example discussed was pregnancy. By obtaining permission to analyze employees’ medical information, companies such as Castlight are able to look at factors such as search queries and whether employees have been filling their birth control prescriptions to predict pregnancies. Some commentators expressed concerns that this type of information could be used by companies in improper ways. Read More